KHOPOTSO: It would seem that even in South Africa the debate is leaning heavily towards making the HIV test a routine practice in public health. Jonathan Berger, a researcher at the AIDS Law Project, is one of those in support of routine testing for HIV. But, he cautions that certain pre-conditions must be adhered to.

JONATHAN BERGER: The routine offer of HIV testing should be introduced in South Africa as long as it is not   introduced in a way that dispenses with the need for pre and post-test counselling and proper informed consent. It not only makes good public health sense. It’€™s also a constitutional requirement.

KHOPOTSO: Supreme Court of Appeal Judge, Mr Justice Edwin Cameron ‘€“ who himself lives openly with HIV ‘€“ also welcomes the notion of making testing for HIV a routine exercise. But he, too, believes that certain principles, which guarantee the respect of the individual, must guide such a policy.

EDWIN CAMERON: I’€™m scared of talking about routine HIV testing without specifying the pre-conditions. We’€™ve got to have an environment where treatment is being offered as a real option to the patient; we’€™ve got to have an environment where confidentiality is respected. Confidentiality is different from disclosure. Disclosure is the choice of the patient. And we’€™ve got to have an environment where our legal and constitutional guarantees of non-discrimination, which the Constitutional Court so boldly reinforced in the Hoffman vs SAA decision, where those are realities that people feel safe-guard them in their lives. Once we have those three pre-conditions I’€™ve mentioned, then we can move to a position where HIV testing becomes routine.      

KHOPOTSO: But should testing for HIV be made routine in South Africa? Or could we run the risk of conflict between human rights’€™ principles and good public health practices? Jonathan Berger of the AIDS Law Project is well aware of the debate.  

JONATHAN BERGER: There are ways of respecting people’€™s human rights and giving effect to them in a way which makes good public health sense. I have not yet heard any convincing argument, which explains why violating someone’€™s right to privacy or confidentiality makes good public health sense.   I have yet to hear a convincing argument. The arguments are often made along the lines that pre-suppose that the right to privacy, the right to confidentiality, precludes a doctor or another health care worker, from offering testing. And that in my view is an incorrect understanding of the right. I think one of the crucial points is that there is no disconnect between good public health and human rights. The two support each other and feed into each other.              

KHOPOTSO: Perception of risk is a highly personal issue and relatively small numbers of South Africans have come forward voluntarily to test and find out their status. A recent survey by Wits University’€™s Reproductive Health Research Unit and loveLife, shows that among the youth who tested positive in 2003, 60% did not believe that they were at risk of infection. Now, to what extent can routine testing improve attitudes towards testing for HIV? Here’€™s Edwin Cameron.

EDWIN CAMERON: It’€™s a process involving a lot of vicious circles that we’€™ve got to turn into beneficence circles, if we possibly can. At the moment the stigma is so great that people don’€™t want to be tested; and because they don’€™t want to be tested they don’€™t know their HIV status; because they don’€™t know their HIV status, they’€™re not talking about it to anyone’€¦ Once we break down the stigma ‘€“ not just about AIDS and HIV ‘€“ but the stigma about being tested, we can get a greater circle of people who’€™re talking about their own HIV status. So, the beneficence circle will be the more people who say ‘€˜yes, I was tested; yes, I’€™m HIV positive; yes, I have chosen to go on to treatment,’€™ the more other people will follow their example.                  

KHOPOTSO: Jonathan Berger of the AIDS Law Project.

JONATHAN BERGER: I think if properly implemented the routine offer of testing can go a long way to de-stigmatising HIV and AIDS. I think if it is offered at every opportunity in the health care system, regardless of someone’€™s health status, that could be a really positive development. But if it’€™s done in a way that the test is only done when someone comes in presenting with symptoms of AIDS, then that has the potential to further stigmatise HIV and AIDS’€¦ We need to find ways of routinely offering HIV testing both within and outside of the health care system.  

KHOPOTSO: After more than a week of trying to get the national Department of Health’€™s views on the matter of routine testing for HIV, the department has failed to comment. Meanwhile, the subject is so topical that Health-e has learnt that the Nelson Mandela School of Medicine is planning a research project on the cost-effectiveness of the policy compared to the current VCT service.                

E-mail Khopotso Bodibe